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Types of support that individuals can offer through social networks of social support in Community Programs for prevention and control of Diabetes Mellitus.. IntroductionThe health of the population is a product of the society and at the same time an indispensable contribution to economic growth and political stability. If you are eligible for our Type 2 Diabetes study you may be compensated for your time and travel. Community United for Human Growth linked to Institutions of Higher Education in Health is responsible for the design and implementation of educational programs and guides the training of the health promoters for the development of mutual-help groups (human development nucleus).
In Latin America, the Program for Education of Non-insulin-dependent Diabetics-Latin America (PEDNID-LA) was proposed, which was implemented simultaneously in Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Mexico, Paraguay, and Uruguay, demonstrating satisfactory results for the adoption of healthy lifestyles (Gagliardino & Etchegoyen, 2001).
Daryl Norwood Diabetes CasePresentationR.C is a 57-year-old man with Type 2 diabetes first diagnosed two years ago. Daryl Norwood Weight changes should be monitored to assess the need for more aggressive treatments or diet restriction.
A human development nuclei is a group integrated by 10 to 15 adults of nearby communities with similar interests.
In this regard, it is necessary for the Ministry of Health to forge alliances with other public and private actors, including organizations of the civil society, because it has been shown recently that one of the key elements that contribute to maintenance of health is the support that is received from interpersonal interaction. In Mexico, the Ministry of Health’s General Directorate of Health Promotion developed the Health Promotion Operational Model in 2006.
They are mainly involved in the practice of self-care, mutal-help, and self-promotion guidelines established by the program.
At present, there has been a significant increase worldwide of chronic degenerative diseases, among which Diabetes mellitus (DM) is prominent. Based on Ottawa Charter functions, the model integrates health promotion activities within the overall health care system (Santos-Burgoa et al., 2009).
However, the results relative to the implementation and effectiveness of the model have not been reported. In this respect, the International Diabetes Federation estimates that 285 million people around the world suffer from DM.
The model is based fundamentally on the integral development of the person, understood as a process that is carried out throughout and until the end of the person’s lifetime.
Each year, an additional seven million persons develop diabetes (International Diabetes Foundation [IDF], 2011). It implies becoming active in many ways, making use of and potentiating the resources possessed.
In addition to its contributions to hyperglycemia, alcohol has a negative interaction on the drugs Metformin and Simvastatin that can cause liver toxicities. This disease is the leading cause of death in Mexican population and is the most cost-intensive item for the nation’s health care system. It is a process of transformation and continuous growth in which the social capital is fundamental. To achieve adequate control of diabetes, lifestyle modifications are an important part of therapy.
The majority of patients with diabetes in Mexico are in poor metabolic control (Villalpando et al., 2010a). Dietary restrictions, increase in physical activity, and gradual weight loss will be more beneficial than taking medication, alone.
In this respect, the current care model has not been effective for the prevention and control of DM. Thus, it is necessary to develop feasible strategies for adapting the current care model into a context of shared responsibility between the community and the health-team system (Villalpando et al., 2010b). In this chapter, we present a community participation model for the prevention and control of diabetes mellitus.
This model establishes as its fundamental strategy the implementation of a formal health-promoters training program so that program participants will achieve empowerment and constitute a social capital of benefit to themselves through active participation in the community with the practice of self-care, mutual aid, and self-promotion in an organized and systematic social network (Mendoza-Nunez et al., 2009a). Social support networks and healthThe study of social support and its repercussions on the state of health, well-being, and Quality of life (QOL) has experienced significant development dating from the last three decades of the XX Century, above all in some related disciplines, such as preventive medicine, public health, community psychology, social work, anthropology, and sociology.
Notwithstanding this, self-help groups, as they are now known, arose in the 1930s in the U.S.
The basic elements of social support networks comprise social capital, which is defined as the potential exchange of opportunities of a social network. On the other hand, in order to understand the determinants of the wellness-sickness of individuals and populations, it is necessary to explore the biological, social, and psychic spaces of humans. Therefore, social capital depends in large measure on the social contacts possessed by the individual (Burt, 1997).
Each of these dimensions constitutes a viewpoint on wellness-sickness and on the factors affecting this.
None of these dimensions is independent of the others, nor is any sufficient for summarizing the significance of health and what the determinants of the latter are. This should be assumed by the entire society and depends on the capacity of the State to guarantee access to education, health services, safety, and a healthy environment. In addition, the social control that is exercised by means of regulations, sanctions, or interventions can also exert an influence on attitudes and changes in conduct (Arechabala & Miranda, 2002). The manner of conceptualizing health and disease should evolve so that it is not only the result of consensuses of normality and abnormality, of statistical tables or measurements by techno-scientific apparatuses, but rather, the result of a dialog in which the scientific, subjective, and contextual aspects of biopsychosocial humans participate (Caponi, 1997). Therefore, a suitable social network is considered as an open, multicenter system made up of informal (family, friends, community) and formal components (professional and institutional), with defined objectives and goals framed within a program that, through the empowerment of individuals, achieves maximal health and well-being according to their sociocultural context.
At present, it is recognized that one of the basic strategies for the prevention and control of diabetes mellitus is the establishment, coordination, and monitoring of social support networks as part of public policy (Mendoza-Nunez et al., 2009b). Social support networks are a potential source of well-being and health, because health can be transmissible and the vehicle is the social support network.6. Notwithstanding its transitory situation, the way of looking at health by those wielding power over more or less extensive population groups defines the way of acting in relation to their health and the purposes and forms of utilizing their resources (Chapela, 2008a).In this work, we understand health as “the capacity of the human corporeal nature to decide and contract viable futures and of reaching these”. This definition of health, on the one hand, conceives of the subject as body-subjectivity, that is, as only one thing, and on the other, sets forth a cross-disciplinary and multi-conceptual position on health and ponders the subject in collective fashion (Chapela, 2008a). Empowerment involves self-strengthening, control, self-power, self-confidence, making decisions of one’s own accord, a fitting life according to one’s values, the capacity to fight for one’s rights, independence, to the right to make one’s own decisions. This definition allows us to disassociate health from sickness, to understand that the former is an essential part of the subject and not solely a state or a moment in life. The latter term shows us that the subject has a great deal to do with the construction of health at the individual as well as at the collective level, without forgetting that the human corporeal-nature capacity of deciding and constructing futures is mediated not only by the individual’s world vision, by history, that is, by past, present, and future happenings that have permeated the person’s being and the individual’s being in the world, but also by the social guidelines that structure the ways that subjects proceed, without forgetting the psychobiological dimension in which aspirations, wishes, sensations, and emotions, and, of course, actions take place, having the political and economic dimensions as a framework (Chapela, 2008a). In this regard, in order to exercise empowerment in an efficient and efficacious manner, it is indispensible to consider four key elements (Narayan, 2002):Access to information. Health Promotion (HP)The notion of HP is also complex and controversial, and to date, a consensus has not been reached with regard to its significance. Individuals should be included in decision-making to ensure that the use of public and private resources responds to the real needs of the population. Public servants and those responsible for Non-governmental organizations (NGOs) should respond for their policies, actions, and the use of funds.Local organizational capacity.
According to the Ottawa Charter, HP is a process that permits people to increase control over their health to improve it.
The population should possess the ability to organize itself and to work in a group, with the goal of participating actively in the community intervention programs that are developed in its milieu. It constitutes a political, social, and global progression that encompasses not only actions directed precisely toward strengthening the abilities and capacities of individuals, but one that is also directed toward modifying social, environmental, and economic conditions with the aim of mitigating their impact on public and individual health.
HP is the process that allows people to increase their control over the determinants of health and, consequently, to improve it. Participation is essential to sustain action in matters of health promotion (Ottawa Charter for the Promotion of Health, World Health Organization [WHO] Geneva, Switzerland 1986).However, after Ottawa, multiple health promotions may be found in distinct countries and practiced by distinct international organizations, although these affirm that they have adopted the Ottawa Charter as their directorate. Likewise, it has been recognized that education is basic for achieving empowerment (Aujoulat et al., 2007). It has also been cited that social and educational activity in community interventions avoids isolation (Cattan, 2005). The model contemplates a Community United for Human Growth (CUHG), whose purpose is to coordinate the large net of social networks of mutual-aid groups, in which self-care is a daily practice for the prevention and control of diabetes mellitus, as well as for achieving maximal well-being and health as components of one’s human development (Figure 2). Thus, our proposal establishes the elimination of the stigma of the disease and proposes a model of community intervention for integral human development in which maintenance of health constitutes the key factor. This model avoids the social prejudices that label “groups of diabetics as sick people who do not follow the rules”, which generates social rejection and abandonment of the group in many participants, who “seek at all times the cure for their incurable disease” in order to “stop being part of the group of diabetics”. In 1996, our research group proposed a community care model, considering the active participation of the individual in order to achieve maximum QOL in their social milieu (Mendoza-Nunez et al., 1996). In this respect, although the results have been satisfactory, we adapted the model in 2004 according to the paradigm of active aging and subsequently submitted this to a process of investigation to determine its feasibility and pertinence (Martinez-Maldonado et al., 2007). As previously mentioned, our proposal is not limited to older adults, because the principles and strategies can be applied to adult population in general.The model establishes as the key element the formation of promoters of integral human development. In this regard, promoters function as mutual aid-group coordinators, establishing self-care and self-management actions for their members’ well-being and social development, in which health maintenance is fundamental.
Therefore, any community program directed toward human development in which maintenance of health and improving QOL are considered should establish the mechanisms that allow for its harmonic and complementary execution.
Similarly, mutual aid includes the reasoned and requisite behavior that a group of individuals who share similar problems and who are aware of the advantages and commitments acquired adopts on voluntarily accepting to be part of the group.
With regard to self-management, this involves the actions that an individual or self-help group performs in an autonomous manner, in an expected and optimal way, taking into consideration the elements and mechanisms of formal and informal social support networks.
The CUHG is one of the elements of the social support network, responsible for training Human Development Promoters (HDP), who are in turn responsible for coordinating mutual-aid groups denominated Human Development Nuclei (HDN), which are made up of 10 to 15 adults groups according to their affinities and the geographical closeness to their domiciles.
For this, self-care programs should be implemented for the healthy and sick individual, with pre-established evaluation, surveillance, and primary care-action protocols. Thus, we recommend the implantation of programs of recreation, adaptation, and psychosocial and occupational self-improvement under an anthropological focus, according to the individual’s interests, age, schooling, gender, health state, socioeconomic situation, etc. The model establishes flexible general guidelines that could be adopted for rural and urban population, as well as for groups of adults of different sociocultural and economic conditions. As an integral part of the model, the implementation has been established of a “Healthy Life” Program in which, under a constructivist focus, participants establish the strategies for adopting healthy lifestyles, utilizing a self-efficacy instrument to maintain and strengthen behavioral changes.
Model viabilityThe model has been implemented in Mexico with an older adult population from rural and urban areas.
On the other hand, the anthropological aspects associated with the disease should be considered in community interventions, because cultural aspects determine negative lifestyles (sedentary life style and inadequate nutrition), which raises the risk of diabetes mellitus (Martorell, 2005).For this reason, the purpose of our model is the conformation and integration of a “great network of networks” of mutual-aid groups who practice scientifically founded principles of daily self-care and self-management for their human development.
In this light, the prevention of chronic diseases, and especially diabetes mellitus, constitutes one of the basic objectives. Healthy lifestyles and diabetes mellitusHealthy lifestyles constitute key elements for preventing and controling DM. Among the factors linked with compliance with healthy lifestyles, we are able to highlight self-efficacy and self-esteem. Nonetheless, it is important to cite that these recommendations should be adapted to age, gender, occupation, health state, socioeconomic level, food preferences, and food availability.
ConclusionThe proposed model of community participation for the prevention and control of diabetes mellitus establishes as fundamental elements a broad concept of health, the concepts of citizenship and empowerment, and as self-care strategies, mutual aid and self-management with the support of social networks.
This model represents important savings of economic resources for the State.Finally, to strengthen the viability of the model, it is indispensable that the State establish public policies that permit the development of this type of model.
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